Care Coordination Manager
2 months ago
POSITION SUMMARY:
The Care Coordination Manager plays a pivotal role in ensuring effective communication with external case managers from referring healthcare facilities and managed care organizations (MCOs). This position is essential for the collection, interpretation, and certification of data from third-party payers throughout the patient care continuum, from pre-admission to discharge. The manager will also conduct ongoing medical necessity evaluations and provide interdisciplinary team support to meet MCO requirements.
KEY RESPONSIBILITIES:
- Secure necessary pre-authorizations and certifications for specified services from MCOs, while communicating any changes in benefit status to relevant departments.
- Conduct continuous medical necessity assessments, including pre-service, concurrent, and retrospective reviews, by analyzing clinical data and submitting documentation to update patient status with MCOs.
- Act as a liaison between the residential program and MCOs to streamline the reimbursement process.
- Facilitate the appeal process for MCO denials and non-covered services by collaborating with directors.
- Perform medical record reviews for all managed care patients within the initial 24 to 72 hours of admission, followed by weekly assessments to achieve optimal clinical and financial outcomes, including:
- Engaging with managed care residents to assist in selecting appropriate provider resources and identifying quality, cost-effective services across the care continuum.
- Serving as a resource for the interdisciplinary team regarding MCO admission, continued stay, and discharge planning requirements.
- Ensuring early identification of covered care and facilitating claim approvals when guidelines are met.
QUALIFICATIONS:
- Minimum of 2 years of experience in case management or utilization review.
- Associate degree required; Bachelor's degree preferred.
- Strong analytical and problem-solving skills to interpret and analyze statistical data.
- Excellent verbal, written, organizational, and interpersonal communication abilities.
- Proven ability to effectively communicate with senior leadership and collaborate with clinical and non-clinical teams.
- Demonstrated capacity to work collaboratively with peers and senior leadership on projects and presentations.
-
Care Coordinator
3 months ago
New York, United States Village Care Full timeCare CoordinatorVillageCareMAX112 Charles Street, New York, NY 10014VillageCareMAX is looking for a motivated individual for this Full-Time role to provide assistance to care managers and members in coordinating services and requests. The Care Coordinator will work to authorize services based on plan of care and ensure that services are initiated and...
-
Care Coordinator
1 month ago
New York, New York, United States Independence Care System Full timeCare Navigator Job DescriptionAt Independence Care System, we are seeking a highly skilled Care Navigator to join our Health Home team. As a Care Navigator, you will play a critical role in coordinating members' overall care, ensuring they receive the necessary health and social supports to maintain their health, mobility, and independence in the...
-
Care Manager
1 week ago
New York, New York, United States Care Collab Full timeJob SummaryCareCollab is seeking a skilled Care Manager to lead the engagement and coordination of comprehensive care and services for high-utilization Medicaid members with chronic medical and behavioral health conditions.This role is crucial in addressing the holistic needs of our members, including behavioral, medical, and social aspects. Key...
-
Care Coordinator
3 weeks ago
New York, New York, United States Elite Home Health Care Full timeAbout Elite Home Health CareElite Home Health Care is a licensed home care agency that provides professional homecare services in the New York Metropolitan area, Central, and Upstate NY Regions. Our mission is to deliver compassionate, professional, and integrity-centered care to our clients.Job SummaryAs a Coordinator at Elite Home Health Care, you will...
-
Care Coordinator
6 days ago
New York, New York, United States HCS Home Care Full timeJob DescriptionJob Title/Position: Care CoordinatorReports To: Care Coordinator SupervisorJOB DESCRIPTION SUMMARYAs a Care Coordinator with HCS Home Care, you will play a vital role in coordinating home care services for managed care patients. Your responsibilities will include establishing and maintaining the patient's plan of care, establishing and...
-
LPN Patient Care Coordinator
2 weeks ago
New York, New York, United States Patient Care Full timeJob Title: LPN Patient Care CoordinatorThe LPN Patient Care Coordinator is a vital member of our Patient Care team, responsible for assisting the Patient Care Manager in coordinating high-quality care to home health patients.This includes ensuring all team staff are skilled and informed, and committed to providing quality care in an efficient manner, in...
-
Care Coordinator
3 days ago
New York, New York, United States Pinnacle Home Care Inc. Full timeAbout the Role:Pinnacle Home Care Inc. is seeking a highly skilled Care Coordinator to join our team. As a Care Coordinator, you will be responsible for ensuring seamless communication between our clinical operations and patients. Your primary focus will be on processing authorizations, intake, and correspondence in a timely manner.Key...
-
Care Coordinator
1 week ago
New York, New York, United States A Plus Care HHC Full timeJob OverviewA-Plus Home Care is seeking a highly skilled and dedicated Care Coordinator to join our team. As a Care Coordinator, you will play a vital role in ensuring that our patients receive the highest quality care and services.Key Responsibilities:Coordinate the scheduling and assignment of Home Health Aides to meet patient needsEnsure that all patients...
-
Administrative Coordinator
2 months ago
New York, New York, United States Multi-Billion Dollar Asset Manager Full timeA leading Multi-Billion Dollar Asset Manager is seeking an experienced professional to provide administrative support on a floating basis. The role will be responsible for all classic corporate administrative tasks with the ability to take on some project-based work. The company has a great culture and offers strong compensation packages (base salary + OT +...
-
Care Management Support Coordinator II
2 weeks ago
New York, New York, United States Fidelis Care Full timeTransforming Healthcare for Our CommunitiesWe're on a mission to change the lives of our 28 million members. As a Care Management Support Coordinator II at Centene, you'll play a vital role in delivering exceptional healthcare services. Our company is dedicated to transforming the health of our communities, one person at a time.As a key member of our team,...
-
Care Coordinator
2 weeks ago
New York, New York, United States A Plus Care HHC Full timeJob Title: Case CoordinatorJob SummaryA-Plus Home Care is seeking a highly skilled and dedicated Case Coordinator to join our team. As a Case Coordinator, you will play a vital role in ensuring the delivery of high-quality care to our patients.Key ResponsibilitiesCoordinate the scheduling and assignment of Home Health Aides to meet patient needsEnsure all...
-
Care Management Coordinator
3 weeks ago
New York, New York, United States MedElite Full timeJob Title: Care Management CoordinatorMedElite is seeking a highly skilled Care Management Coordinator to join our team. As a key member of our care management program, you will be responsible for assigning and scheduling patients to be seen for our care management program.Responsibilities:Program Development: Identify areas for improvement and implement...
-
Care Management Coordinator
2 weeks ago
New York, New York, United States MedElite Full timeAbout MedEliteMedElite is a leading provider of care management services, dedicated to improving the standard of care in skilled nursing and long-term care facilities nationwide. Our innovative approach focuses on delivering high-quality, proactive care directly to the bedside, while saving valuable time and resources for our partner organizations.Job...
-
Care Management Coordinator
3 days ago
New York, New York, United States Metropolitan Jewish Health System Full timeAbout the Role:The Metropolitan Jewish Health System is seeking a skilled Care Management Coordinator to join our team. As a Care Management Coordinator, you will play a critical role in ensuring high-quality, cost-effective care and services for our Elderplan members.Key Responsibilities:Support professional Care Management and/or Clinical Service...
-
Care Coordinator
2 weeks ago
New York, New York, United States Tri-County Care Full timeJob Overview:The Care Manager role at Tri-County Care involves collaborating with individuals with intellectual/developmental disabilities, their families, and relevant providers to ensure a safe, happy, and fulfilling life. This includes identifying goals, building plans, and assisting with support applications to achieve person-centered outcomes.Our team...
-
Care Management Coordinator
4 weeks ago
New York, New York, United States Metropolitan Jewish Health System Full timeAbout the RoleWe are seeking a highly skilled Care Management Coordinator to join our team at Metropolitan Jewish Health System. As a key member of our care management team, you will play a critical role in ensuring high-quality, cost-effective care and services for our Elderplan members.ResponsibilitiesSupport professional care management and clinical...
-
Care Management Coordinator
4 weeks ago
New York, New York, United States Metropolitan Jewish Health System Full timeAbout the RoleWe are seeking a highly skilled Care Management Coordinator to join our team at Metropolitan Jewish Health System. As a key member of our care management team, you will play a critical role in ensuring high-quality, cost-effective care and services for our Elderplan members.ResponsibilitiesSupport professional care management and clinical...
-
Care Management Coordinator
3 weeks ago
New York, New York, United States HR Employer Solutions Group Full timeJob SummaryWe are seeking a highly organized and detail-oriented Care Management Coordinator to facilitate care management services for our clients. As a key member of our team, you will play a critical role in ensuring the smooth and efficient delivery of care management solutions.Key ResponsibilitiesCoordinate and manage care management services for...
-
Care Management Coordinator
1 month ago
New York, New York, United States The Institute for Family Health Full timeCare Management Coordinator Job SummaryThe Institute for Family Health is seeking a highly skilled Care Management Coordinator to oversee the implementation and management of our care management programs. This role requires a strong leader who can supervise program staff, ensure key performance indicators are met, and drive quality improvement...
-
Care Management Coordinator
2 weeks ago
New York, New York, United States MJHS Full timeAbout the Role:We are seeking a skilled Care Management Coordinator to join our team at MJHS. As a key member of our care management team, you will play a vital role in ensuring high-quality, cost-effective care and services for our Elderplan members.Responsibilities:As a Care Management Coordinator, you will support all aspects of care coordination for our...
